Amit Jain, MD, MBA
Amit Jain, MD, MBA, chief of minimally-invasive spine surgery in the department of orthopaedic surgery and associate professor of orthopaedic surgery at Johns Hopkins Medicine in Baltimore. HopkinsMedicine.org
Have you tried medication, exercise, even physical therapy for your back pain but nothing is helping? Perhaps your doctor has recommended spinal surgery, but your fears about the outcome are holding you back. Problem: Delaying surgery can create its own cascade of negative events—your back pain worsens…your overall heath declines because you aren’t able to move and exercise comfortably…and in turn, you’re in worse condition to handle surgery when it becomes inevitable.
Bottom Line Personal asked Amit Jain, MD, associate professor of orthopaedic surgery at Johns Hopkins Medicine, how to know if it’s time to have the surgery and how to manage your recovery.
Fear of surgery and negative consequences, such as nerve damage or even paralysis, keep some people from considering surgery—perhaps they have a loved one whose procedure didn’t correct their problem or made it worse…or they are concerned because older procedures were less exacting. But recent advances have led to minimally invasive approaches that reduce healing time and pain, and sophisticated imaging techniques now allow surgeons to visualize the anatomy of the back in ways that weren’t available not that long ago. These also have made it possible for people to have successful surgery even into their 70s.
Still, unless your condition is so severe that surgery is the only option—perhaps you have severe myelopathy (spinal cord compression), severe spinal stenosis (nerve compression), spinal tumors or you’ve had an accident or other trauma—a skilled orthopedist will try all possible conservative measures to ease your pain before suggesting surgery. These include physical therapy to help you move and exercise more easily as well as medication.
Signs that you need back surgery: Your back pain is constant and getting progressively worse…your symptoms indicate nerve damage—tingling, numbness or weakness in the arms or legs, including foot drop (difficulty lifting the front part of the foot) or difficulty with grip strength…and/or loss of bowel or bladder control due to pressure in the cervical or lumbar spine. Physical changes that require surgery, such as nerve or spinal cord compression or a herniated disk, should be visible on an MRI as well.
Having a necessary surgical procedure will help you avoid more physical damage, and you’ll be able to enjoy a future without back pain. Of course, any surgery’s risk increases as we move into our 70s (mostly because of other health issues that develop as we age), but many seniors still can benefit from back surgery when it’s warranted.
Working with the right doctor should help allay your fears. Both orthopaedic spine surgeons and neurosurgeons with specialized training in spine surgery can perform spinal procedures. Don’t be afraid to get a second opinion if you have any concerns or want to see if other surgical techniques are available for your condition. Above all, make sure you have a clear understanding of what outcome you can expect.
There are many different spinal procedures. The right one for you depends on your specific condition. Most fall into one of the following categories…
Decompression surgery relieves chronic pain or loss of function due to a bone spur, injury, herniated disk, narrowing of the spinal canal from spinal stenosis or a tumor pressing on spinal nerves. Two of the most commonly performed decompression surgeries…
Laminectomy is surgery to remove all or some of the lamina (part of the bone that makes up each vertebra), bone spurs and/or thickened ligaments. This is done to create more room in the spinal column and, in turn, ease pain.
Discectomy is surgery to remove all or part of a herniated disc. Normally, discs act as shock absorbers to cushion vertebrae, but when a disc slips out of place or is damaged from wear and tear and bulges out, it can put pressure on nerves and cause pain. A common symptom is sciatica, a sharp, shooting pain along the sciatic nerve that runs down the back and the length of a leg, usually on one side of the body.
Spinal fusion. Variations of this procedure are used to fuse or attach specific vertebrae to one another with special cement and/or hardware to stop the pain that occurs when they move. Spinal fusion can correct conditions such as instability in the spine, scoliosis and/or severe disc degeneration.
The procedure you have, as well as whether it can be done using minimally-invasive, possibly robotic procedures or a more traditional open surgery with a large incision, depends on your condition and how many vertebrae are involved. With minimally-invasive surgery, the surgeon makes a few small incisions through which special surgical instruments can reach the spine. This often spares surrounding tissues and leads to a shorter recovery. Advances in robotics for spinal procedures can assist with more precise placement of necessary surgical hardware, such as rods and screws, in the spine.
Some minimally-invasive surgeries are done on an outpatient basis, while traditional procedures could require a few nights in the hospital. Your recovery time will depend on the type of surgery you had.
In general, recovery from decompression surgery—laminectomy and discectomy—is relatively quick. You should be able to get back to work and many activities within a few weeks. Pain, numbness and/or weakness along the path of the nerve that was under pressure should improve within this time, although healing may continue for a year or more.
For spinal fusion, you likely will be out of work for four to six weeks…longer if your job is strenuous. If you’re older and had extensive surgery, it could take four to six months before you can return to certain activities.
Follow all the instructions you’re given, especially concerning movement. Lifting, bending, going up and down stairs, physical activities and driving likely will be off limits for a few weeks to a few months. You’ll need to be conscious of how you sit and your sleeping position. You will probably be told to take short walks every day for the first few weeks after surgery and then slowly increase how far you walk.
If your surgeon prescribes physical therapy, attend these sessions—you’ll learn how to move in ways that prevent pain, keep your back in a safe position and prepare you for getting back to all the activities you love.
